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© 2009 University of Washington

Publications

 

Abstracts of NWRSICS articles from the 2006-2011 grant cycle

 

2009

J Spinal Cord Med. 2009;32(1):6-24.
Measuring depression in persons with spinal cord injury: a systematic review.
Kalpakjian CZ, Bombardier CH, Schomer K, Brown PA, Johnson KL.
Model SCI System, University of Michigan, Department of Physical Medicine and Rehabilitation, 300 N. Ingalls, Room NI 2A09, Ann Arbor, MI 48109, USA. clairez@umich.edu
BACKGROUND/OBJECTIVE: Depression has been studied extensively among people with spinal cord injury (SCI). However, basic questions persist regarding the reliability and validity of depression measurement in the context of SCI. The objective of this study was to evaluate the state of knowledge of depression measurement in persons with SCI. METHODS: English-language peer-reviewed citations from MEDLINE, CINAHL, PsycINFO, ProQuest, Google Scholar, and Web of Science from 1980 to present. Two reviewers screened 377 abstracts on SCI and depression topics to identify 144 containing classifiable psychometric data. All 144 were reviewed by 6 reviewers. Twenty-four studies reporting psychometric data on 7 depression measures in SCI samples were identified, including 7 validity studies. RESULTS: Reliability data were limited to internal consistency and were
consistently good to excellent across 19 studies. Validity data were limited to concurrent validity, construct validity, and/or clinical utility in 10 studies. Measures were comparable with respect to internal consistency, factor structure, and clinical utility. Results are limited to peer-reviewed, English literature, and studies were not judged for quality. CONCLUSIONS: Greater attention should be paid to the psychometric evaluation of established measures. Although existing evidence may not justify universal screening, we recommend depression screening in clinical practice when patients may be seen by nonpsychology personnel. There is insufficient evidence to recommend one screening measure over another. Therefore, selection of measures will depend on clinician preferences. Psychometric studies are needed to show test-retest reliability, criterion
validity, and sensitivity to change to improve depression recognition and treatment.

J Spinal Cord Med. 2009 (in press)
Validity, Accuracy, and Predictive Value of Urinary Tract Infection Signs and Symptoms in Individuals with Spinal Cord  Injury on Intermittent Catheterization
Massa L, Hoffman JM, Cardenas DD.
Objectives: Determine the validity, accuracy, and predictive value of the signs and symptoms of urinary tract infection (UTI) for individuals with spinal cord injury (SCI) using intermittent catheterization (IC); and the accuracy of individuals with SCI on IC at predicting their UTI.Design: prospective cohort.Participants: 56 community-based subjects with SCI on IC.Main Outcome Measures: Presence of UTI as defined as bacteriuria with a colony count >= 105 CFU/mL and at least one sign or symptom of UTI.Methods: Analysis of data collected monthly during the initial three months of a one-year randomized controlled trial. The data consisted of an inventory of signs and symptoms plus laboratory results from urinary analysis and culture. Results: Overall, “cloudy urine” had the highest sensitivity (79.2%), highest accuracy (86.9%), and a positive predictive value of 61.3%.  The highest specificity was for “fever” (99.1%); however, it had a very low sensitivity (8.3%). Patients were able to predict their own UTI with an accuracy of 67.7%.Conclusion: The UTI signs with the highest sensitivity were “cloudy urine” and “foul smelling urine”.  The UTI signs and symptoms can, on average, predict a UTI more accurately than individual subjects can by using subjective impressions of their signs and symptoms.

Arch Phys Med Rehabil. 2009 (in press)
A Randomized Controlled Trial of Hydrophilic Catheters versus Non-Coated Catheters for Reducing the Incidence of Urinary Tract Infections
Hoffman JM, Cardenas DD 
Objective: To test the hypotheses that  hydrophilic catheters reduce the incidence of symptomatic urinary tract infections (UTIs) in persons with spinal cord injury on self-intermittent catheterization (IC). Design: Randomized controlled trial. Participants/methods: 56 subjects on IC with recurrent UTIs and who met eligibility criteria were enrolled, examined and treated for any significant bacteriuria (defined as > 105). They were then randomized to either the hydrophilic catheter group or to a non-hydrophilic control group.  Urine was collected each month for the first 3 months and then every 3 months for 1 year and with any symptomatic UTIs.Results: Of the 56 subjects enrolled, 45 completed the study (22 in the treatment group; 23 in the control group).  There were no significant differences in demographics, including gender, between the treatment group and the controls except for more tetraplegic subjects in the control group (P < .05). 71% of the treatment group and 52% of the control group were male.  The total number of symptomatic UTIs treated with antibiotics was significantly fewer in the treatment group than in the control group (P < .05). 70% of the control group had at least 1 antibiotic treatment episode compared to only 50% of those using the hydrophilic catheter (P = .18). There was no significant difference in the incidence of bacteriuria or symptomatic UTIs among the two groups. Level of injury and years with injury were unrelated to symptomatic UTIs but being female increased the risk of UTIs (P < 0.01). Conclusion: Hydrophilic catheter usage was associated with reduced numbers of treated UTIs as compared to standard non-hydrophilic catheters in persons with SCI using self-IC; however, the study is limited by a small sample size. Women on self-IC were more likely to develop UTIs regardless of the catheter type suggesting that the benefits of the lubrication may be more important in males. 

2008

J Spinal Cord Med. 2008;31(2):177-84.
Improving the efficiency of screening for major depression in people with spinal cord injury.
Graves DE, Bombardier CH.
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine,
Houston, Texas, 77030, USA. dgraves@bcm.tmc.edu
BACKGROUND/OBJECTIVE: To investigate the metric properties, relative efficiency, sensitivity and specificity, and positive predictive value of a short form of the Patient Health Questionnaire-9 (PHQ-9) that may be used as a screening test for depression. METHODS: Data from the National Spinal Cord Injury Statistical Center
Database containing 3,652 records with complete data for the PHQ-9 were analyzed using Confirmatory Factor Analysis, Item Response Theory Graded Response Model analysis, and sensitivity and specificity analysis of classification. RESULTS: A scale comprised of items 1, 2, and 6 from the PHQ-9 has a relative efficiency of
0.66 compared to the 9-item scale. Using this 3-item scale and a cutoff score of 3 or more provides specificity of 0.93 and sensitivity of 0.87; a cutoff of 4 provides specificity of 0.95 and sensitivity of 0.82. The shorter version of the scale reduces the effect of response bias caused by gender. The relative efficiency of the 9-item scale is 0.88 for women compared to men; the 3-item scale increases the relative efficiency to 0.93. CONCLUSION: A 3-item scale provides adequate information for clinical screening purposes. Cutoff scores of either 3 or 4 are acceptable and present options for decision making within a particular clinical setting. Additionally, the 3-item scale reduces the effect of gender of the respondent on the score obtained.